NHS continuing healthcare Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.
Where can NHS continuing healthcare be provided? NHS continuing healthcare can be provided in a variety of settings outside hospital, such as in your own home or in a care home.
Am I eligible for NHS continuing healthcare? NHS continuing healthcare is for adults. Children and young people may receive a “continuing care package” if they have needs arising from disability, accident or illness that can’t be met by existing universal or specialist services alone. To be eligible for NHS continuing healthcare, you must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to: • what help you need • how complex your needs are • how intense your needs can be • how unpredictable they are, including any risks to your health if the right care isn’t provided at the right time Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change. You should be fully involved in the assessment process and kept informed, and have your views about your needs and support taken into account. Carers and family members should also be consulted where appropriate. A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment. If you aren’t eligible for NHS continuing healthcare, you can be referred to your local council who can discuss with you whether you may be eligible for support from them. If you still have some health needs then the NHS may pay for part of the package of support. This is sometimes known as a “joint package” of care.
Information and advice The process involved in NHS continuing healthcare assessments can be complex. An organisation called Beacon gives free independent advice on NHS continuing healthcare. Visit the Beacon website or call the free helpline on 0345 548 0300.
NHS continuing healthcare assessments Clinical commissioning groups, known as CCGs (the NHS organisations that commission local health services), must assess you for NHS continuing healthcare if it seems that you may need it. For most people, there’s an initial checklist assessment, which is used to decide if you need a full assessment. However, if you need care urgently – for example, if you’re terminally ill – your assessment may be fast-tracked. 10
Initial assessment for NHS continuing healthcare The initial checklist assessment can be completed by a nurse, doctor, other healthcare professional or social worker. You should be told that you’re being assessed, and be asked for your consent. Depending on the outcome of the checklist, you’ll either be told that you don’t meet the criteria for a full assessment of NHS continuing healthcare and are therefore not eligible, or you’ll be referred for a full assessment of eligibility. Being referred for a full assessment doesn’t necessarily mean
Full assessment for NHS continuing healthcare Full assessments for NHS continuing healthcare are undertaken by a multidisciplinary team (MDT) made up of a minimum of 2 professionals from different healthcare professions. The MDT should usually include both health and social care professionals who are already involved in your care. You should be informed who is co-ordinating the NHS continuing healthcare assessment. The team’s assessment will consider your needs under the following headings: • breathing • nutrition (food and drink) • continence • skin (including wounds and ulcers) • mobility • communication • psychological and emotional needs • cognition (understanding) • behaviour • drug therapies and medication • altered states of consciousness • other significant care needs These needs are given a weighting marked “priority”, “severe”, “high”, “moderate”, “low” or “no needs”. If you have at least one priority need, or severe needs in at least 2 areas, you can usually expect to be eligible for NHS continuing healthcare. You may also be eligible if you have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability. In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided. The assessment should take into account your views and the views of any carers you have. You should be given a copy of the decision documents, along with clear reasons for the decision. You can download a blank copy of the NHS continuing healthcare decision support tool.